Healthcare Provider Details

I. General information

NPI: 1396657185
Provider Name (Legal Business Name): MONICA ELIZA SEGOVIA-HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 CHURCH ST N STE 102
CONCORD NC
28025-4373
US

IV. Provider business mailing address

13425 HOOVER CREEK BLVD STE 205
CHARLOTTE NC
28273-0327
US

V. Phone/Fax

Practice location:
  • Phone: 704-502-9397
  • Fax:
Mailing address:
  • Phone: 704-502-9397
  • Fax: 980-422-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024489
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: